Please refer to the Green Book for more details.

Advised for use in adults aged 18 yea­rs and above:

• Moderna mRNA (Spikevax) bivalent Original ‘wild-type’/Omicron BA.1. Dose: 50 micrograms

• Moderna mRNA (Spikevax) Original ‘wild-type’ vaccine. Dose: 50 micrograms

• Pfizer-BioNTech mRNA (Comirnaty) bivalent Original ‘wild-type’/Omicron BA.1 vaccine. Dose: 30 micrograms

• Pfizer-BioNTech mRNA (Comirnaty) ‘wild-type’ vaccine. Dose: 30 micrograms

Advised for use in persons aged 12 to 17 years:

• Pfizer-BioNTech mRNA (Comirnaty) bivalent Original ‘wild-type’/Omicron BA.1 vaccine. Dose: 30 micrograms

• Pfizer-BioNTech mRNA (Comirnaty) ‘wild-type’ vaccine. Dose: 30 micrograms

Advised for use in persons aged 5 to 11 years:

• Pfizer-BioNTech mRNA (Comirnaty) ‘wild-type’ vaccine paediatric formulation. Dose 10 micrograms. Available for ‘off-label’ use as a booster dose (currently UK approved for primary course vaccination in children aged 5 to 11 years)

Exceptional circumstances:

• Novavax Matrix-M adjuvanted wild-type vaccine (Nuvaxovid), dose 5 micrograms (Spike protein) with 50 micrograms adjuvant, may be used ‘off-label’ as a booster dose for persons aged 18 years and above when no alternative clinically suitable UK-approved COVID-19 vaccine is available (see the Green Book)

In the previous advice published on 15 August it was noted that the Pfizer-BioNTech mRNA bivalent vaccine was under assessment by the Medicines and Healthcare products Regulatory Agency (MHRA). This assessment has now been completed and the vaccine authorised for use as a booster in this age group as of 2 September 2022.

1. COVID-19 vaccine effectiveness against the omicron (BA.2) variant in England, 24 May 2022.
2. Vaccines and Related Biological Products Advisory Committee, 28 June 2022 presentation: mRNA-1273.214 Moderna COVID-19 investigational bivalent vaccine (Original + Omicron).
3. Vaccines and Related Biological Products Advisory Committee, 28 June 2022 meeting presentation: Pfizer/BioNTech COVID-19 Omicron-modified vaccine options.
4. Interim COV-BOOST data shared in confidence.
5. Investigation of SARS-CoV-2 variants: technical briefings

The Joint Committee on Vaccination and Immunisation (>JCVI) has been asked by the Secretary of State for Health and Social Care to consider the options for and timing of a booster programme to revaccinate adults in order to reduce mortality, morbidity and hospitalisations from COVID-19 over the 2021 to 2022 winter period and through 2022, as well as to minimise the COVID-19 case infection rate and the chance of new variants emerging.

With increasing levels of social mixing and close social contact, it is expected that during winter 2021 to 2022 SARS-CoV2 will co-circulate alongside other respiratory viruses, including seasonal influenza virus. Seasonal influenza and SARS-CoV-2 viruses have the potential to add substantially to the ‘winter pressures’ usually faced by the NHS, particularly if infection waves from both viruses coincide. The timing and magnitude of potential influenza and SARS-CoV2 infection waves for winter 2021 to 2022 are currently unknown.

In JCVI’s view, the primary objective of a 2021 COVID-19 booster programme is to maintain protection against severe COVID-19 disease, specifically hospitalisation and deaths, over winter 2021 to 2022. This is exceptional advice aimed at maintaining protection in those most vulnerable, and to protect the NHS. This advice is based on evidence from a number of sources, including UK data on the duration of vaccine-induced protection against severe COVID-19. As not enough time has passed to enable a clear understanding of the level of protection 6 months after completion of the primary vaccine course in all persons, extrapolation of some data has been required.

Taking a precautionary position, JCVI considers that on balance, it is preferable to ensure protection is maintained at a high level throughout the winter months in adults who are more vulnerable to severe COVID-19, rather than implement a booster programme too late to prevent large increases of severe COVID-19 in previously double vaccinated individuals.

At present, it is not known whether recurrent boosters will be required in the long term. This advice on booster vaccination therefore only applies to this highly active phase of the pandemic. This programme is timed to maximise the impact of a booster programme on individual protection against severe disease and to protect the NHS during the winter months.